Oriental Insurance
Happy Family Floater Policy Platinum
The Happy Family Floater Policy Platinum is an okay pick with an interesting perk - coverage for maternity & assisted reproductive treatments up to ₹2 lakhs after a 3-year waiting period. This maternity coverage is one of the highest in the industry. On the other hand, the plan has some caveats including disease-wise sub-limits, no no-claim bonuses and no restoration benefits. Coming to the insurer, the provider has a solid track record across its Claim Settlement Ratio. However, the high numbers on its Incurred Claim Ratio reflect the insurer's issues with financial stability, which is a red flag when it comes to analysing a brand's future sustainability and future claim settlement potential. Additionally, the insurer's poor number of network hospitals doesn't add to the appeal either. Overall, the plan is an okay pick and if you are looking for a comprehensive health insurance plan, you might as well start shopping around for other options.
What's good here?
Extended coverage for Assisted Reproductive Treatments
This plan offers coverage for assisted reproductive treatments upto 2 lakhs and make you wait 3 years before covering this expense. Also, you’ll only get the benefits if both, you and your spouse are enrolled in a single-family floater plan.
This plan offers coverage for assisted reproductive treatments upto 2 lakhs and make you wait 3 years before covering this expense. Also, you’ll only get the benefits if both, you and your spouse are enrolled in a single-family floater plan.
You’ll never have to split the bill
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Day Care treatments covered
If you’re hospitalized for less than 24 hours in lieu of a minor procedure, then the insurer will cover these costs too. Think dialysis, chemotherapy or minor surgeries.
Pre & Post hospitalization expenses covered
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Covers Alternative Medicine
Think of getting Ayurvedic, Homeopathic or other alternative treatments to cure an illness? Your insurer will cover you fully, up to the sum insured.
What's bad here?
Restrictions on the rooms you can pick and much more
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more - Read more here
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more - Read more here
Has disease wise sub-limits
Your insurance cover won’t be fully available in case you are treated for Modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Your insurance cover won’t be fully available in case you are treated for Modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
What's okay here?
Reasonable waiting period for pre-existing diseases
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Some coverage if you are forced to hospitalize at home
The insurer will pay up to ₹50,000 if you are forced to hospitalize at home due to a medical condition or the hospital running out of beds. In insurance lingo, they call this a policy with domiciliary cover.
Doctor consultations are not covered
In the event, you are feeling sick and you want to visit your family physician for a general checkup, the insurer will cover the costs, up to a certain limit. In this case, it’s ₹5,000 in a block of 3 years if you have opted for a cover of 25 lakhs or above.
Maternity benefits offered
The insurer will also cover expenses related to maternity— Think hospitalization expenses incurred while giving birth. But they’ll only pay upto 2.5% of the sum insured and make you wait 2 years before covering this expense. Also, you’ll only get the benefits if both, you and your spouse are enrolled in a single-family floater plan.
What's lacking here?
No Restoration Benefit
Some policies will tell you - Even after you claim part of the cover on one occasion, you will have the full cover restored, if you are hospitalized another time during the same year. So if you have a family cover and multiple members of the family are hospitalized in the same year, this feature will come in handy. Unfortunately, this policy offers no such benefit.
Some policies will tell you - Even after you claim part of the cover on one occasion, you will have the full cover restored, if you are hospitalized another time during the same year. So if you have a family cover and multiple members of the family are hospitalized in the same year, this feature will come in handy. Unfortunately, this policy offers no such benefit.
No Bonus for being healthy and not claiming insurance
Some policies offer you extra cover if you go an entire year without claiming your insurance. This policy, however, offers no such benefit.
Your insurer doesn’t provide free health check-ups
If you want to get a full-body checkup just to make sure you’re in fine working condition, be ready to pay for it yourself.
Add-ons
Life Hardship Survival Benefit
With this add-on you get a lumpsum payment in the event you are diagnosed with critical illnesses outlined in the policy document.
Personal Accident cover
With this add-on, the insurance company will payout a lumpsum amount based on the cover chosen, in case the selected insured member encounters total or partial disablement or accidental death.
Geographical Extension To SAARC Countries
With this add-on, the insurer will extend the base coverage for insured members to SAARC countries without charging any additional premiums. The insured member needs to make a written request to the insurer to avail of this benefit.
Waiver of Proportionate Deduction Clause
With this paid add-on, the insurer will enhance the clause of proportionate deduction of the room rent benefit by 50% or 100% based on the option chosen.
Frequently Asked Questions
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